Humana RN Quality Improvement Clinical Lead - San Antonio, TX in San Antonio, Texas

*Role: *Quality Improvement Clinical Lead

Assignment:Quality Improvement - Medicare/HEDIS/Stars

Location:San Antonio, TX - this is an office based role with up to 50% travel throughout SW TX as needed

Assignment Capsule

Link consumer experience goals to market with development of behavioral intervention tools and application support for quality initiatives . Drive clinical collaboration with key groups.

  • Design strategy to support implementation of quality clinical goals

  • Collaborate the management and delivery of reporting analysis on profitability and quality performance for internal and external entities on Provider groups

  • Perform and/or collaborate with all Market Departments on analysis of trend issues, cost saving opportunities, quality metrics and documentation opportunities.

  • Make recommendations to market leadership through detailed analysis/consideration of financial, quality and documentation implication with Market and the Provider groups.

  • Serve as focal point for provider groups questions; filter questions to appropriate market source and ensure responses are completed in a timely fashion.

  • Participate in community calendar and attend all JOC meetings as assigned

  • Build long lasting partnerships enabled by clinical infrastructure, including process development and implementation

  • Develop methods to ensure providers are aware and engaged in member program participation or how Humana enables the group’s programs and/or UM delegation

  • Monitor and manage status of internal Service Level Agreements (SLA) including sharing relevant clinical metrics, strategy and tactics among various areas/teams who impact the provider experience for coordination and collaboration

  • Support Groups and clinics with added infrastructure (example: have a "screening bus" at a location to support a community drive)

  • Partner with provider groups and the community to manage unique population health challenges in support of achieving enterprise goals

Role Essentials

  • Active RN license in TX

  • BSN or advanced degree

  • Experience in population health

  • Background in utilization management

  • Proven successful experience in completing efficient health-related research, with associated analysis and conclusions

  • Ability to develop and strengthen networks and relationships, both inside and outside the organization

  • Experience leveraging resources to create exceptional outcomes

  • Executive presence and communication, written and verbal

  • Excellent PC skills

  • Strong organizational and analysis skills

Reporting Relationships

  • You will report to a Clinical Manager. This area is under the leadership of the SVP & Chief Operations Officer.

Additional Information

As part of our hiring process for this opportunity, we will be using an exciting interviewing technology called Montage Voice to enhance our hiring and decision-making ability. Montage Voice allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.

If you are selected for a first round interview, you will receive an email correspondence (please be sure to check your spam or junk folders often to ensure communication isn’t missed) inviting you to participate in a Montage Voice interview. In this interview, you will listen to a set of interview questions over your phone and you will provide recorded responses to each question. You should anticipate this interview to take about 15 to 30 minutes. Your recorded interview will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews.

Title: RN Quality Improvement Clinical Lead - San Antonio, TX

Location: Texas-San Antonio

Requisition ID: 170698

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.